COMPARISON BETWEEN PUSH-TYPE ENTEROSCOPY AND RADIOLOGICAL EXAMINATIONOF THE SMALL-BOWEL IN PATIENTS WITH GASTROINTESTINAL-BLEEDING AND IRON-DEFICIENCY ANEMIA OF OBSCURE ORIGIN

Objectives.-A radiological examination of the small bowel is often per formed in case of gastrointestinal bleeding of obscure origin. More re cently, push-type enteroscopy has been reported as a valuable tool in this indication. The purpose of this study was to compare the diagnosi s efficiency of these two procedures. Methods.-From February 1994 to F ebruary 1996, 40 patients (mean age : 52 years) with obscure gastroint estinal bleeding (iron-deficiency anemia without obvious cause of bloo d loss or malabsorption : n = 17 ; macroscopic gastrointestinal bleedi ng : n = 23) were examined by small bowel follow-through and push-type enteroscopy (jejunoscopy n = 19 ; double way examination n = 21). Eac h patient had negative upper and lower gastrointestinal tract endoscop ies prior to small bowel examinations. Results.-Small bowel follow-thr ough revealed only one lesion potentially responsible for blood loss ( 2.5 %), corresponding to a jejunal leiomyoma. Push-type enteroscopy de tected small bowel lesions potentially responsible for blood loss in 6 patients (15 %). The lesions were located in the jejunum in 5 cases ( arteriovenous malformations : n = 3 ; metastasis : n = 1 : leiomyoma : n = 1), in the ileum in 1 case (leiomyoma). The efficiency of push-ty pe enteroscopy for the detection of a small bowel lesion was of 22 % i n case of macroscopic bleeding and of 6 % in case of iron-deficiency a nemia. Push-type enteroscopy also revealed lesions previously undetect ed by gastroscopy or colonoscopy in 8 patients (20 %). Conclusion.-Pus h-type enteroscopy was more effective than small bowel follow-through to detect the origin of obscure gastrointestinal bleeding. Push-type e nteroscopy revealed a cause of bleeding in 35 % of patients, located i n the small bowel in only 15 % of the patients.